From the Guidelines
Cone Beam Computed Tomography (CBCT) is highly recommended for evaluating endodontically treated teeth, particularly when 2D imaging is insufficient to clarify anatomical relationships or define the internal structure of dysmorphic dental roots 1.
Key Points
- CBCT provides three-dimensional imaging that reveals details not visible on conventional two-dimensional radiographs, including missed canals, root fractures, resorption, and periapical lesions.
- For post-treatment evaluation, a small field of view CBCT with the lowest radiation dose necessary is recommended to balance diagnostic quality with radiation exposure.
- CBCT is particularly indicated when patients present with persistent symptoms after root canal treatment, when conventional radiographs show ambiguous findings, or when planning surgical endodontic procedures.
- The superior spatial resolution of CBCT allows clinicians to visualize the complex root canal anatomy, identify the exact location of periapical pathology, and determine the proximity to vital structures like the maxillary sinus or mandibular nerve.
Clinical Considerations
- CBCT should be used selectively following the ALARA (As Low As Reasonably Achievable) principle for radiation exposure, with consideration of the specific clinical question being addressed and whether the information gained will impact treatment decisions 1.
- In cases where CBCT is necessary, it is essential to use the lowest radiation dose necessary and to target the imaging as much as possible to reduce patient radiation exposure to a minimum.
Evidence-Based Recommendation
- The use of CBCT is recommended when 2D imaging is insufficient to clarify anatomical relationships or define the internal structure of dysmorphic dental roots, with a strength of recommendation of A and a degree of evidence of IV 1.
From the Research
Role of CBCT in Evaluating Endodontically Treated Teeth
- CBCT imaging can be used in all phases of endodontic treatment, including diagnosis, treatment planning, and post-treatment assessment and follow-up 2.
- CBCT has superior validity and reliability compared to conventional imaging systems in the management of endodontic diagnosis and complications 2.
- The use of CBCT in endodontics can provide essential information for diagnosis, treatment planning, and follow-up, especially in complex cases such as root resorption, missed extra canal, fusion, oblique root fracture, and horizontal root fracture 3.
Diagnostic Accuracy of CBCT
- CBCT scans have been shown to have high sensitivity (93%), specificity (78%), and accuracy (88%) for detection of vertical root fractures in endodontically-treated teeth 4.
- CBCT can detect important radiological signs that are not always visible in periapical X-ray, such as root fractures, root resorption, and MB2 canals in nontreated maxillary molars 5.
- CBCT can provide a detailed assessment of the teeth and surrounding alveolar anatomy, allowing for accurate diagnosis and treatment planning 5.
Limitations and Considerations
- CBCT imaging should be prescribed only after weighing the cost of radiation exposure with the benefit of the diagnostic information that can be obtained from the scan 6.
- The use of CBCT in endodontics should be considered on a case-by-case basis, taking into account the complexity of the case and the potential benefits of the diagnostic information provided by CBCT 2, 6.
- CBCT imaging may not always be necessary for routine endodontic cases, but can be a valuable tool in complex or difficult cases where conventional imaging systems may not provide sufficient information 2, 3.